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L4RJ Chapter Membership Application
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Contact information
First Name
Last Name
Preferred Language
English (United States)
Spanish
Chinese (China)
Tagalog
Korean
Persian (Iran)
Arabic
Khmer (Cambodia)
Navajo, Navaho
Email
Street Address
City
Postal Code
State/Province
- Select -
Phone Number
Phone Type
Mobile
Landline
Fax
Membership Type
LA Chapter - Student or Part-time Worker
LA Chapter - Full-time Worker
SD Chapter - Student or Part-time Worker
SD Chapter - Full-time Worker
Demographic Information
Pronoun
She
He
They
Zie
None of the Above
Gender Identity
Agender, nongendered, or neutrois
Cisgender
Gender non-conforming
Non-binary
Trans/Transgender
Are you a parent?
Yes
No
Current Occupation
Architecture & Engineering
Arts, Design, Entertainment, Sports, & Media
Building/Grounds Cleaning & Maintenance
Business & Financial Operations
Community & Social Service
Computer & Mathematics
Construction & Extraction
Education, Training, & Library
Farming, Fishing, & Forestry
Food Preparation & Service
Healthcare Practitioners & Techs
Healthcare Support
Installation, Maintenance, & Repair
Legal
Life, Physical, & Social Science
Management
Office & Administrative Support
Personal Care & Service
Production
Protective Services
Sales
Transportation & Material Moving
Grassroots Info
Issues Interest
Access to Abortion
Comprehensive Sex Ed
Contraceptives & Family Planning
Economic Justice
Educational Justice
Environmental Justice
Health & Wellness
HIV/STI Prevention
Immigrant Rights
LGBTQ Rights & Queer Liberation
Racial Justice
State Violence & Incarceration
Teen Pregnancy Prevention
Violence Prevention
Youth Sexuality/ Young Parents
RJ
Volunteer Interests
Admin/Office
Canvassing
Community organizing
Fundraising
Graphic Design
Media/Communications
Outreach/Tabling
Phone banking
Policy Advocacy
Public Speaking/Presentations
Research
Policy advocacy/Lobbying
L4RJ Membership Application
Tell us in a few sentences why reproductive justice is important to you and your community?
Please let us know what topic areas you are most interested in learning or developing. (Check all that apply)
Community Organizing, Outreach and Education
Communications and Media
Story Collection
Research
Fundraising and Grant Writing
Policy Advocacy
Voter Engagement and Outreach
What do you hope to gain from your membership in Latinas4RJ? What interests you most about becoming a member of Latinas4RJ?
What do you hope to contribute to the leadership chapter? What professional and personal qualities would you like to share in a space like Latinas4RJ?
Please share any skills or experience you bring to the chapter (Ex. Graphic Design, Social Media, Research experience, etc)
Are you involved in any other community organizations or causes? (Please explain briefly)
Do you need childcare, travel, or any type of support or accommodations to attend Latinas4RJ activities? (Please explain below)
Yes
No
Please explain what type of support or accommodations you need to attend Latinas4RJ activities?
COMMITMENTS: Please review and agree the following commitments in order to submit your membership application.
I can contribute the annual membership dues ($50 for full-time employees, $25 for part-time/student
I can commit to at least two policy advocacy activites per year
I can commit to at least two community engagement activities per year
I commit to attend monthly chapter meetings (usually weekends for up to 3 hours) and additional activity planning meetings
If you have any questions or concerns, please contact michelle@clrj.org or 323-230-3077